Provider Demographics
NPI:1205027190
Name:TROLLAN, GREGORY M
Entity Type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:M
Last Name:TROLLAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2231 JORDAN AVE
Mailing Address - Street 2:
Mailing Address - City:JUNEAU
Mailing Address - State:AK
Mailing Address - Zip Code:99801-8050
Mailing Address - Country:US
Mailing Address - Phone:907-789-1812
Mailing Address - Fax:907-789-7168
Practice Address - Street 1:2231 JORDAN AVE
Practice Address - Street 2:
Practice Address - City:JUNEAU
Practice Address - State:AK
Practice Address - Zip Code:99801-8050
Practice Address - Country:US
Practice Address - Phone:907-789-1812
Practice Address - Fax:907-789-7168
Is Sole Proprietor?:No
Enumeration Date:2007-08-06
Last Update Date:2007-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEPC-0000285101YP2500X
AK322101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional